Does This Constitute Psychotic Depression?

By Kristina Randle, Ph.D., LCSW

I’ve been depressed since I was probably fifteen years old and was diagnosed with MDD and dysthymia last year. However, there are some troubling things that happen when I get depressed (apart from the depression itself). I’ve had three episodes of derealization/depersonalization in my life; when I was eight, when I was thirteen, and last year. The first two came on kind of out of nowhere and the last one was with a major depressive episode– each lasted about a month. When I’m depressed I also look really distorted and wrong in the mirror, like I’m not a person and I’m different from everyone else. I also have this overwhelming feeling of being wrong and being disgusting and evil and it’s a secret I have to keep from everyone, so I compensate by being really nice and generous but it’s because deep down I know there’s something inherently wrong with me. I also get really paranoid, like if I see someone on the bus acting a little bit shifty I become convinced they have a bomb or a gun. I also think that everyone is staring at me because I look wrong and that they know there’s something wrong with me. If I overhear people talking, I think they’re talking about me. I have mild social anxiety but it becomes grossly distorted when I’m depressed– I think that everyone who talks to me and says something nice is playing a trick on me. I just feel paranoid and on edge all the time during these episodes– and it only happens when I’m depressed. Is this normal, or is something besides depression going on?

A. It is difficult to know what is wrong. Paranoia, anxiety, and episodes of derealization/depersonalization are not symptoms of depression. They are symptoms of other disorders. A thorough evaluation of your symptoms could reveal what is wrong.

In the meantime, it would be helpful if you had someone who could help you stay grounded in reality. Do you have a friend or a trusted relative whom you could call during difficult times? Having that type of support could help to control your symptoms.

The most efficient way to deal with this problem is to be evaluated as soon as possible. Generally, when symptoms develop they should be examined and treated without delay. That is especially true when it comes to symptoms associated with psychosis such as paranoia. I would recommend being evaluated by both a psychiatrist (or other mental health professional) and a medical doctor. The purpose of seeing a medical doctor would be to rule out a physical cause of your symptoms.

Please take care. I wish you the best.

Dr. Kristina Randle

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Last reviewed: By John M. Grohol, Psy.D. on 26 Dec 2011

APA Reference
Randle, K. (2011). Does This Constitute Psychotic Depression?. Psych Central. Retrieved on December 19, 2014, from http://psychcentral.com/ask-the-therapist/2011/12/26/does-this-constitute-psychotic-depression/